Search results: food strategy

I haven’t posted an industry-funded study for a while, but here’s a good one.  This is a systematic review published in the Annals of Internal Medicine attacking dietary advice to eat less sugar on the grounds that such advice is not scientifically justified.

This one doesn’t pass the laugh test.

What are dietary guidelines supposed to do?  Tell people to eat more sugar?

This review is particularly peculiar:

• It was funded by the International Life Sciences Institute (ILSI), a food-industry front group.
• Two of the four authors consult for ILSI, and one of the two is on the scientific advisory board of Tate & Lyle, the British sugar company.
• The authors admit that “given our funding source, our study team has a financial conflict of interest and readers should consider our results carefully.”  No kidding.
• It was published by a prestigious medical journal.  Why?
• It is accompanied by an editorial that thoroughly demolishes every single one of the authors’ arguments.

I can understand why ILSI wanted this review.  Many of its funders make sugary foods and drinks.  They would like to:

• Cast doubt on the vast amounts of research linking excessive sugar intake to poor health.
• Discredit dietary guidelines aimed at reducing sugar consumption.
• Head off regulatory attempts to tax or label added sugars.

In funding this study, ILSI is following the tobacco industry playbook to the letter.  Strategy #1 is to cast doubt on the science.

When the 2015 Dietary Guidelines came out with a recommendation to restrict sugar intake to 10% of calories or less, the Sugar Association called it“agenda-based, not science-based.”  The Annals review says international sugar guidelines do not “meet criteria for trustworthy recommendations and are based on low-quality evidence.”

I detect a theme here.

But I ask again: what are dietary guidelines supposed to do?  We cannot lock up large numbers of people and feed them controlled amounts of sugar for decades and see what happens.  Short of that, we have to do the best we can with observational and intervention studies, none of which can ever meet rigorous standards for proof.  So this review is stating the obvious.

Take a look at the accompanying editorial.  After destroying each of the flawed premises of this review, it concludes:

Industry documents show that the F&B [Food & Beverage] industry has manipulated research on sugars for public relations purposes….Accordingly, high quality journals could refrain from publishing studies on health effects of added sugars funded by entities with commercial interests in the outcome. In summary, our concerns about the funding source and methods of the current review preclude us from accepting its conclusion that recommendations to limit added sugar consumption to less than 10% of calories are not trustworthy. Policymakers, when confronted with claims that sugar guidelines are based on “junk science,” should consider whether “junk food” was the source.

I don’t ever remember seeing a paper accompanied by an invited editorial that trashes it, as this one did, but this incident suggests a useful caution.

Whenever you hear that something isn’t “science-based,” look carefully to see who is paying for it.

The press coverage

• The New York Times: A Food Industry Study Tries to Discredit Advice About Sugar (I’m quoted)
• NPR: How Much Is Too Much? New Study Casts Doubts On Sugar Guidelines (I’m quoted)
• EurekAlert: Dietary sugar guidelines are based on low quality evidence
• WTKR:The debate continues on how much sugar is OK
• Time: Should You Trust the New Research About Sugar?
• CSPI: Industry-funded Study Designed to Cast Doubt on Sugar Advice
• Daily Mail (Reuters): So we CAN eat more sugar? Controversy as top journal publishes Coca Cola-funded study claiming sweets are NOT as bad as feds claim (I’m quoted)

PepsiCo, yesterday, announced that it had launched its sustainability report with an agenda for 2025. 

The sustainability promises look good, but reporters called me for comments only on the first goal in its Products agenda:

1. At least two-thirds of Pepsi’s global beverage portfolio volume will have 100 calories or fewer from added sugars per 12-ounce serving.

For the record, the other Product goals are:

2. At least three-quarters of its global foods portfolio volume will not exceed 1.1 grams of saturated fat per 100 calories.

3. At least three-quarters of its global foods portfolio volume will not exceed 1.3 milligrams of sodium per calorie.

The reporters’ questions assumed that Pepsi plans to reduce the sugar in its full-sugar beverages.

Maybe, but that’s not clear from the press release or the report.

Here’s what I want to know:

1. The baseline: What proportion of Pepsi drinks already have fewer than 100 calories per 12 ounces?  Pepsi makes loads of beverages that meet that target—Gatorade, bottled waters, diet sodas.
2. The marketing plan: Will the marketing dollars shift from full-sugar to lower-sugar options?

I ask, because Pepsi’s track record on sugar reduction is not encouraging.  In 2009, Pepsi set a goal to reduce the average amount of added sugars in its drinks by 25% by 2020.

The result?  An increase in average sugars of 4% so far (Pepsi got into trouble with investors who wanted marketing focused on full-sugar beverages).

Pepsi’s sustainability report says the company is working hard to find ways to reduce sugars and “these efforts could yield significant progress.”   Let’s hope they do.

The report also explains how the company plans to reach its lower-sugar goal:

• Reformulating
• Creating new low-and no-calorie drinks
• Making smaller sizes
• Boosting promotion of lower-calorie drinks

I hope the company does these things, despite its unfortunate record on sugar promises.  We need to wait and see whether the company delivers on this one.

But I’m thinking: Surely this announcement must be designed to head off the ongoing soda tax initiatives.  Pepsi is pouring millions of dollars into fighting the taxes directly and through its membership in the American Beverage Association.

Pepsi wants to have things both ways: to appear to promote healthier beverages while it is fighting public health measures to reduce soda intake.

Let’s give the company the benefit of the doubt and hope it delivers on its promises—while doing everything we can to get those taxes passed.

Here’s one of the articles that quotes me:

The last time Pepsi tried to position itself as doing something for health, its investors got very upset,” Marion Nestle, a professor in the Department of Nutrition, Food Studies & Public Health at New York University, said in an email. In 2012, investors got mad at PepsiCo CEO Indra Nooyi for focusing on getting revenue from healthy products, Business Insider reported.

“[PepsiCo] will continue to do everything it can to promote its most profitable products,” Nestle said. “These, alas, tend to be the ones with full sugar.”

I am late getting to the FDA’s July announcement of the release of its work plan for the next ten years, Foods and Veterinary Medicine (FVM) Program’s Strategic Plan for fiscal years 2016-2025.

The FDA organized the plan under goals for:

• Food safety
• Nutrition
• Animal health
• Organizational excellence

The FDA based the plan on basic principles:

1. Public health is the first priority
2. Partnerships are the key to success
3. Scientific expertise and research are the foundation
4. The program is committed to operating openly and transparently

Comments can be submitted on the strategic plan at any time.  Instructions for how to do so are here.

One possibility is to ask for further details.  The plan does not say how the FDA will accomplish the objectives, how much it will cost to achieve them, or whether it has adequate funding for everything it does (hint: it doesn’t).

Some of what it wants to do is puzzling.  For example, one Nutrition objective is this:

2.1: Provide and support accurate and useful nutrition information and education so consumers can choose healthier diets consistent with the Dietary Guidelines for Americans and other evidence-based recommendations.

I assume this refers to Nutrition Facts labels and menu labels, but one of its sub-objectives is:

Strategy 2.1d: Promote collaboration with stakeholders, including industry, consumer, and public health groups, to enhance consumer nutrition education directed towards age and demographic groups with specific needs.

I wish the report said more about this.  Surely the FDA is not suggesting that the food industry take responsibility for nutrition education?  I hope not.

The documents:

• Federal Register Notice
• FDA Home Page for the Plan
• The Strategic Plan for 2016-2015
• Blog: Charting a Path Forward on Food Safety, Nutrition and Animal Health

Tomorrow afternoon, First Lady Michelle Obama will be talking about the impact of her Let’s Move! initiative to end childhood obesity in a generation.  She is expected to say something there about the future of the White House kitchen garden.

In the meantime, two reporters wrote accounts of her legacy yesterday (both quote me).

VOX

Julia Belluz talks about “how Michelle Obama quietly changed what Americans eat.”

I spoke with a dozen people who worked closely on her campaign, as well as the health and food policy researchers who studied it…I learned that some of the very things that made Michelle Obama sometimes appear soft — the industry collaborations, the emphasis on exercise — were part of the shrewd strategy that made her effective. Through her leadership, the Obama administration seized on a moment when America started paying attention to food, and made fighting obesity a top priority — both symbolically and legislatively.

Obama planted a garden, waged snappy social media campaigns, and worked behind the scenes with researchers, lawmakers, heads of government departments, schools, and food giants to quietly change what Americans eat.

Even observers who previously worried about Obama’s food industry partnerships now called her advocacy “brilliant,” “unprecedented,” and a “godsend.”

SAN FRANCISCO CHRONICLE

Sarah Fritsche writes about “how the Obama administration led an American food movement” and provides an extraordinarily impressive timeline of accomplishments from 2009 on.

These are impressive stats, but as the Obamas enter their final months in the White House, one is left to wonder what exactly will be the lasting impact and legacy of the administration.

In an increasingly divisive political scene, and with the November election up for grabs, it may be too soon to tell. While childhood obesity rates appear to be leveling off, says Nestle, it takes a long time to gather data and track results. And, although the food industry is on alert, if the incoming administration takes less of a watchdog approach, these strides in food policy and awareness run the risk of losing momentum.

“Will it be undone is the big question,” says Nestle. “It depends a lot on who gets elected.”

The much delayed UK government’s plan for dealing with childhood obesity has finally been released to virtually universal dismay over the missed opportunity.

The strategy is now a Plan, and says it is “the start of a conversation.” It reconfirms the government’s intentions to implement a soft drink tax, subject to consultation, but does not include a range of measures recommended by its own Public Health England and by last year’s House of Commons Health Committee, such as reduce food marketing and controls on retail promotions. It relies on voluntary sugar reduction by the food industry and encouraging parents to help increase children’s physical activity to meet the recommended 1 hour per day.

It’s fun to read the criticisms: nobody minces words.

An editorial in The Lancet

The UK Government’s long-anticipated response to the childhood obesity crisis disappointed everyone. From doctors, health charities, and celebrities to the very industry it seeks to propitiate, the Childhood Obesity Plan, published with as little noise as possible in the summer recess, has met with resounding criticism. As a Comment in today’s Lancet highlights, the strategy has been delayed for a year, and in that time it has been watered down to a vague Plan with no teeth.  Reading the report from start to finish gives the impression that its authors haven’t.

The Lancet editorial continues

The absence of curbs on industry practices that contribute to childhood obesity—promotions of unhealthy food in supermarkets and restaurants; advertising of junk food through family TV programmes and social media—seems like a gift to industry.

The Lancet is especially miffed because it ran a series on obesity last year that made it clear what kinds of policies needed to be enacted.

Also in The Lancet, World Obesity’s Tim Lobstein and Klim McPherson say

What we read in the government’s Plan is nothing particularly new, nothing bold, and very little that can actually be measured to assess the Plan’s success. It is a document that is not only a disappointment to public health professionals, but also evidence of a government walking away from its moral duty to protect the health of children, and its fiscal duty to protect the NHS from the consequent costs.

The Association for the Study of Obesity (ASO) issued a statement:

the plan is a lost opportunity to provide leadership and commitment in tackling childhood obesity as part of a whole systems approach. It lacks bold actions that are needed to reverse the current high levels of child obesity such as: a ban on junk food advertising before the 9pm watershed; reduction in portion sizes; reformulation targets for industry that address high energy density foods; curbing the promotion of unhealthy foods in supermarket; investment to increase and extend evidence-based child weight management services. All of these would be robust, evidence-based actions and would start to tackle the root causes of obesity in this country.

Again in The Lancet, Yoni Freedhoff and Kevin Hall point out the need for more sensible weight loss studies:

Over the past several decades, dozens of randomised controlled trials have compared various diets for the treatment of obesity. Ideally, such studies should have provided strong evidence for clear clinical recommendations and also put a stop to society’s endless parade of fad diets. Unfortunately, the evidence base remains contested and the “diet wars” continue unabated…What is especially striking is the similarity of the long-term pattern of mean bodyweight change, irrespective of diet prescription.⁵ …Fewer resources should be invested in studying whether or not a low-carbohydrate diet is marginally better than a low-fat diet, or whether intermittent fasting provides marginally better short-term outcomes than a so-called Paleo diet.

Their study provides further evidence why we need stronger policies for preventing obesity.  It’s too bad the UK couldn’t do better.

And if you think things are any better in New Zealand…

The food industry has hit out at claims in a leading journal that New Zealand’s childhood obesity plan was flawed and that the government valued corporate profit over public good. The Food and Grocery Council said that an editorial in the New Zealand Medical Journal, which claimed that the government’s strategy did not address excess sugar intake, was “flawed on many fronts.  Moreover, the FGC complained that its response to the article, solicited by Fairfax Media, was not run.

Addition, September 14

• Jamie Oliver weighs in—The Guardian

Yesterday, the FDA opened for public comment its long-awaited guidance for industry about reducing salt in processed food products.  The guidance affects about 150 products.  It gives baseline data for those products and sets targets for salt reduction.

Please note that I am using the word salt, not sodium.  The targets are for sodium reduction.  Most dietary sodium comes from salt added to processed foods and pre-prepared foods.  Salt is 40% sodium.  The target dietary intake of 2300 mg sodium comes to just under 6 grams of salt a day, which is not particularly low.  It is, however, lower than current intake levels.

In a blog post, FDA official Susan Mayne said the link between sodium intake and blood pressure is “strong and well documented,” but

In fact, it’s very difficult in the current marketplace NOT to consume too much sodium. The average intake today is over 3,400 milligrams—significantly more than the 2,300 milligram limit recommended by federal guidelines. And it’s not just adults who are eating too much sodium: Children and teens consume more than is recommended.

Vox, for example, provides a terrific chart on the amounts of sodium in foods.  It starts with this:

Susan Mayne goes on to explain that

the FDA assessed the sodium content of thousands of products in the marketplace and engaged with experts in industry, academia, and government to get the best available scientific and technical input. We know that sodium has important functions in many foods, such as taste, texture, and microbial safety… Our approach encourages gradually reducing sodium in the majority of foods that contain it…Moreover, our draft targets apply to processed and prepared foods that are eaten both at home and outside the home.

Despite the voluntary nature of the guidance and the lengthy timeline (up to ten years) for implementation, the makers of processed foods are sure to object.  At their urging, the House committee on appropriations, in draft report language, urged the FDA to postpone guidance on salt until the CDC and Institute of Medicine update the Dietary Reference Intake standards for sodium intake.

The Salt Institute, the trade association for the salt industry, issued a press release charging malpractice:

The issuance today of new “voluntary” sodium reduction mandates by the FDA is tantamount to malpractice and inexcusable in the face of years of scientific evidence showing that population-wide sodium reduction strategies are unnecessary and could be harmful. This effort will limit the food choices of Americans, not increase them as the FDA claims. It will make our food less safe and endanger public health.

In JAMA, CDC Director Thomas Frieden rebuts the scientific arguments point by point and, in my view, demolishes them.  He explains how important this initiative is to public health:

Thirty-nine countries have established sodium targets for foods and meals, with 36 of those adopting voluntary approaches. Setting targets helps create a level playing field for the food industry, supporting reductions already begun by companies such as Walmart, Darden, Unilever, PespsiCo, General Mills, Mars, Nestlé, and others. The United Kingdom set voluntary sodium reduction targets in 2003; from 2003 to 2011 sodium intake decreased 15%. During this same period, average blood pressure decreased, and, following no change in prior years, deaths from ischemic heart disease and stroke decreased by approximately 40% [the reference for this last statement is BMJ Open. 2014;4(4):e004549].

Most people would be healthier cutting down on salt intake.  Food company executives know this.  Politico Morning Agriculture points out that some Big Food companies have joined the public health community in supporting the FDA’s proposal.

The band of strange bedfellows – the American Heart Association, Mars, Academy of Nutrition and Dietetics, Nestlé, PepsiCo, American Public Health Association, Unilever and the Center for Science in the Public Interest – all signed on to a letter last month to Senate Appropriations ag subcommittee Chairman Jerry Moran and ranking member Jeff Merkley to support the FDA on sodium. Find that here.

From a public health perspective, the FDA initiative is a step in the right direction but could go further.  It should have required mandatory salt reduction.  Judging from the Salt Institute’s reaction, this is still a big step.  The New York Times quotes Michael Jacobson:

“The F.D.A. found a sweet spot between doing nothing and regulating…This will at least give the public benchmarks against which we can gauge sodium content of foods.”

FDA resources:  

• Federal Register Notice.  The home page explains how to submit comments by October 31 to Docket No. FDA-2014-D-0055
• Draft Guidance Document in PDF (132KB)
• Draft Food Categories and Draft Voluntary Targets for Sodium Reduction (Appendix Table 1) (XLSX: 43KB)
• Summary Explanation of the Draft Food Categories and Draft Voluntary Targets for Sodium Reduction (Appendix Table 1) (PDF: 277KB)
• Sodium Reduction At A Glance
• Presentation: FDA’s Voluntary Sodium Reduction Initiative (PPTX 3MB) 
• Constituent Update: FDA Issues Draft Guidance to Industry for Voluntarily Reducing Sodium
• Blog: Reducing Sodium in the Food Supply
• At a Glance: Lowering Sodium in the Food Supply
• Frequently Asked Questions on FDA’s Sodium Reduction Strategy
• Additional Information and History of Actions on Sodium Reduction

This morning, I received a query from a scientist:

I have been following your documentation of industry-funded research on health benefits. I’ve been thinking about this issue from the perspective of fruits and vegetables. We know that they are good in general, but how does one fund research to demonstrate that clinically? In particular, how does one get specific about the form and amount that his helpful for specific health benefits?  You may be interested in this press release from the raspberry industry telling about the papers at the Society for Experimental Biology meetings that are relevant to the health benefits of eating raspberries. This seems to be approaching what a good model might look like. I’m interested in your perspective. Furthermore, are the results relevant to nutritionists?

Here’s how I answered it:

Thanks for sending.  I guess my question would be something along the lines of why getting specific about form and amount of specific fruits and vegetables is important for public health.  People don’t eat just raspberries.  They put them in cereal or on desserts.  Raspberries are expensive.  Wealthy, educated and, therefore, healthy people are likely to consume them.  So this looks like marketing research to me—selling raspberries as a superfood.  If you think there is a special benefit to raspberries and that it would be good to quantify it, the best strategy would be to get the research funded by an independent agency.  Otherwise, it’s clearly marketing research (hence the press release).   At least that’s how I see it.

This, of course, gets us back to the question of sponsored research which, as my collection of sponsored studies has shown, almost inevitably produce results favorable to the sponsor.  I love raspberries and don’t doubt for a minute that they are healthy, but a superfood?  I don’t think so.

I’m still working on the descriptive analysis of the year’s collection of sponsored studies.  I will also be giving more thought to such questions, so send them along.

Wonder of wonders, the UK’s Chancellor of the Exchequer, George Osborne, has put a soda tax into his new budget initiative (see BBC account, the video and text of Osborne’s speech, and the Treasury department’s fact sheet on the soda tax).

Here’s how the tax is supposed to work:

Osborne says the tax will bring in £520 million ($732 million) in the first year, and he intends to use it to fund more sports in schools.

But it goes into effect in April 2018.  This is to give the industry time to reformulate products with less sugar.  But—the delay also gives the industry ample time to block the tax.

Public Health England supports the tax (see statement).

But the soda industry wasted no time reacting to this bad news.

• Coke, Pepsi, and other soft drink companies strongly objected.
• The immediate result: a fall in their stock prices.
• The immediate reaction: Sue the government.  On what grounds?  Discrimination.  The tax does not affect sugary juices, milkshakes, or processed foods.

The makers of artificial and alternative sweeteners think this will be a win for them.

Will the tax help reduce obesity?  On its own, that would be asking a lot.

Jamie Oliver, the British chef who favors the tax, says of course it won’t work on its own.  It needs to be accompanied by six additional actions (food labels, better school food, curbs on marketing to kids, etc.).

Why are soda companies so worried about this?  It could be catching.

• Mexico already taxes sodas, and the Philippines, India, and South Africa are considering them.
• Berkeley has already passed a soda tax.
• The proposed tax in Philadelphia looks like it has widespread support.

Will the UK tax stick?  Watch Big Soda pull out every stop on this one.

And think about what they are doing to fight soda taxes when you read or hear that soda companies want to be part of the solution to obesity.